The plaintiff is Jeanette Simonton, RN, a 57-year-old nurse at Kittitas Valley Healthcare, a medical center in Ellensburg, Wash. Because the state recognizes obesity as a disability, the lawsuit accuses the Washington State Health Care Authority of discriminating against her and others who have the disease.
Ms. Simonton was taking Eli Lilly’s weight loss medication Mounjaro in 2022 to help treat her osteoarthritis, but when the drugmaker’s cost assistance dried up, her physician prescribed her Wegovy in February. The Washington State Health Care Authority, which did not respond to the Times‘ request for comment, refused to cover the drug that can cost about $1,000 per month.
“They’re being penny wise and pound foolish,” Ms. Simonton told the Times. “What will they be paying in 10, 15 years if I don’t continue to lose the weight?”
Medicare and some other payers don’t cover weight loss medications — but that trend might change as popular weight management therapies such as Ozempic and Wegovy skyrocket in use. The market for this medication class is predicted to reach $100 billion by 2035.
Ms. Simonton now takes a compounded version of Wegovy — a practice that its maker, Novo Nordisk, is working to restrict. She and her husband told the Times they are reducing their spending on groceries and reducing retirement savings to afford the drug.
Ms. Simonton and her lawyers are asking the state court to deem the case a class action, and they are asking the court to compel the payer to cover weight loss drugs and reimburse Ms. Simonton. Hearings are scheduled for early 2024, according to court documents.
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